An understanding and appreciation of the family’s dietary habits is paramount before nutritional advice and education can begin.
Ideally a home visit around the time of diagnosis by the dietitian should be made as this provides an insight into the family way of life and highlights potential constraints upon future dietary compliance.
Not only will foods vary within households but also the timing of meals and styles of eating.
Special attention needs to be given to the level of psychological and social development of the child and any dietary advice given should be set in the context of the whole family as this helps to prevent psychosocial isolation and makes meal planning within the family easier.
Peer pressure must be acknowledged and discussed as it can contribute to major nutritional changes, especially in adolescence.
Today it is necessary for the paediatric dietitian to be able to provide nutritional advice for an increasing variety of different types of diabetes.
Up until recently childhood diabetes was almost exclusively Type 1 in origin, this however is changing as the incidence of Type 2 diabetes in adolescents is increasing and predicted to continue to increase with the rapid rise in childhood obesity (8, 13).
Diabetes secondary to chronic childhood disorders such as cystic fibrosis and haemoglobinopathies is also increasing, as more of these children live on into young adulthood (14,15).
Other forms of diabetes due to specific monogenetic gene defects of insulin secretion (MODY) are being increasingly diagnosed (16).
There are numerous challenges ahead for the paediatric dietitian treating diabetes.
Despite overwhelming evidence that tight metabolic control matters and can reduce the development of microvascular complications (17), the changes in the environment in which we strive to achieve this level of diabetic control are increasingly hostile to good lifestyle behaviour.
The disestablish- ment of the family unit and with it set family meals has helped fuel the deteriorating diets and rise in consumption of fast foods, and these eating patterns have been confounded by the rise in levels of physical inactivity in young people.
THE NUTRITIONAL MANAGEMENT OF CHILDREN’S DIABETES 55
MAIN NUTRITIONAL RECOMMENDATIONS
These are similar to nutritional recommendations for adults with diabetes (2,3). Children above 5 years should be encouraged to adopt these adult nutritional recommendations, while children under 5 years require a more energy-dense diet, see Table 5.1.